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American Association for Hand Surgery

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Leadership Benchmarks for Academic Hand Surgery Training Programs in the United States
Jason Silvestre, MD, Howard University Hospital, Washington, PA, James Clemmons, MD, Howard University Hospital, Washington, DC, Benjamin Chang, MD, University of Pennsylvania, Philadelphia, PA and Robert Wilson, MD, Howard University, Washington, DC

Introduction: Hand surgery fellowship training programs exist primarily at departments and divisions of orthopedic and plastic surgery in the United States. To date, benchmarks are lacking that define the qualifications for these positions including scholarly activity, academic characteristics, and training pedigree. This study characterizes hand surgery fellowship directors (FDs).

Materials & Methods: American Medical Association's Residency and Fellowship Database (FREIDA) was queried for hand surgery fellowship training programs and names were abstracted. Bibliometric data including number of publications and h-index were collected from Scopus. Demographics and educational pedigrees were collected from academic websites and state medical license board data. Scholarly activity was compared between orthopedic and plastic surgery. Pareto analysis and chi square tests were used to compare the concentration of training programs among orthopedic and plastic surgery FDs. Data were presented as means ± SD and t tests were used for comparisons.

Results: 92 hand surgery FDs (73 orthopedic surgery, 17 plastic surgery, 2 general surgery) were identified at 93 hand surgery fellowship programs. The majority were male (87%) and Caucasian (82%). Mean age was 54.5 ± 11 years and most were trained in orthopedic surgery (80%). Average tenure was 12.4 ± 10 years as FD, implying an average age of 42.2 ± 10 years at appointment. Only 16% had an additional degree (8% MS, 7% PhD) and 17% had an additional fellowship (5% microsurgery, 4% arthroscopy/sports). 10% of orthopedic hand surgery fellowship programs were run by plastic surgery residency trained FDs versus 0% of plastic surgery hand fellowship programs run by orthopedic surgery residency trained FD (p < 0.05). Mean h-index was 15.3 ± 9 from an average of 57.0 ± 47 publications cited 1349 ± 2254 times. Orthopedic and plastic surgery hand surgery FDs had similar levels of scholarly activity (p>0.05) and similar ages. Older age correlated with higher h-index values (r = 0.43, p<0.001). 27.4% of orthopedic surgery FDs were trained by their top five fellowship programs whereas 64.7% of plastic surgery FDs were trained by their top five fellowship programs (p < 0.05).

Conclusions: Hand surgery FDs have strong research backgrounds and similar training characteristics despite different training pathways. Women and racial minority groups are largely underrepresented among leadership positions at hand surgery training programs. These benchmarks can help provide a baseline for hiring committees and hand surgeons aspiring to academic leadership positions.

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